(P-344) Medication Regimen Complexity Among Older Adults Admitted to Home Hospice

Background: Polypharmacy is common in older adults admitted to hospice. Medication regimens evolve over time as death approaches, but longitudinal changes in overall medication regimen complexity are poorly described in this vulnerable population.

Objectives: To characterize longitudinal medication regimen complexity of older adults in home hospice.

Methods: We are conducting a pilot clinical trial of older adults admitted to home hospice. The setting is two regionally diverse, multi-office, hospice agencies in the United States. Patients are eligible for the trial if newly admitted to hospice, aged 65 years or older, and prescribed 5 or more medications on admission. Exclusion criteria include being non-English speaking, having a Palliative Performance Score < 40, or active dying at time of eligibility screening. Consenting participants are followed for 6 months or until death. Intervention exposure is a hospice-staff level communication and medication review program to facilitate goal-concordant prescribing, including deprescribing. Measures include medication regimen complexity index (MRCI) and polypharmacy prior to hospice admission, at hospice admission, and at 2-, 4-, 6-, 8-weeks and monthly until death. Descriptive analysis characterizes the longitudinal pattern of MRCI, polypharmacy, and discontinued medications over time.

Results: In this actively recruiting study, we present preliminary analysis of n=9 participants enrolled to date; one participant died prior to data collection. The mean age is 80.6 years (range 69-101), mean pre-hospice MRCI = 16.5 (range 9-29.5), mean hospice admission MRCI = 22 (range 8-29), and mean at-death MRCI = 28.3 (range 5.5-39.5). Increased medication complexity is associated with initiation of hospice symptom management medications. Chronically prescribed daily medications that were discontinued in hospice included antihypertensives (amlodipine, HCTZ), statins (atorvastatin, simvastatin), loratadine, vitamin B12, prednisone, meclizine, and colchicine.

Conclusions: Medication regimen complexity among high in home hospice patients and increases over time. Increases in symptom and pain management medications occurred with minimal discontinuation of questionably beneficial chronic disease medications as patients approached the end of life.